Gynecological tests: types, essence and methods of carrying out. Infections in gynecology Pass all tests in gynecology

Regular visits to the gynecologist are essential. This helps to identify ailments in the early stages and prevent their further development. Every second woman has problems in gynecology, and the state of health of every third insistently requires a detailed examination for the presence of cancer. Therefore, once every 5-6 months, it is simply necessary to undergo a complete gynecological examination for preventive purposes. Find out what awaits you at each stage of the examination by a gynecologist.

1. External examination. Physician first

examines the external genitalia, then proceeds to the study

3. Bacteriological examination. This is an examination of a smear from the vagina and cervix under a microscope.

“As a rule, a smear can detect mushrooms,

"key cells", change

normal flora, says Natalia Ivanovna. And if the smear shows

the presence of infection, but does not reveal the pathogen, prescribe additional

laboratory tests".

The result of this stage of research is usually known through

a few days, but in some modern centers you will be offered

express option.

4. Cytological examination. A mandatory step in the diagnosis of cervical pathology. Mandatory research conducted before her treatment.

superficial layer, the diagnosis can only be made at the transition

Standard gynecological tests - important information about women's health

Hand over standard tests at the gynecologist women are recommended once every 3-6 months. Regular laboratory tests will help monitor the state of the reproductive system, take timely measures in the event of the development of dangerous diseases.

A standard scheduled consultation with a gynecologist always includes a pelvic ultrasound, examination on a chair and tests for infections. If a woman has no complaints, it is enough to pass a simple smear for microscopy. According to the results of the test, the doctor will be able to exclude dangerous infections and microflora disorders.

A patient with complaints of bleeding, cycle disorders, pain and spasms is referred for a comprehensive examination. It also includes standard tests, examination by a gynecologist, ultrasound. Among the additional studies are hormone tests. ELISA and PCR tests for STIs, etc.

For women in menopause, the list of standard tests also includes the study of hormonal levels. A decrease in the concentration of sex hormones can lead to problems with bones, excess weight, and the appearance of tumors.

The medical center in Solntsevo has developed programs for a comprehensive gynecological examination for women of all ages. It is also convenient for us to pass individual standard tests without a referral from a gynecologist. For detailed information about services, please call.

Gynecologist's tests

When making a visit to the gynecologist, it is assumed that, in addition to counseling and examination, certain tests will be taken, with the help of which the doctor will be able to more thoroughly assess the patient's state of health and, if necessary, prescribe treatment, or conduct a more in-depth examination.

Analyzes in gynecology are the starting point in communication between a specialist and a patient. So, what tests can be taken by a gynecologist, and for what purpose? First of all, during the examination, the doctor takes a smear analysis for the flora. It consists in taking secretions from several points: the posterior fornix of the vagina, from the cervical canal and from the urethra, if necessary, they are also taken from the anus, and applied to a special coverslip.

The cost of tests by a gynecologist in our Center can be clarified in the section Service cost

The procedure for taking a smear is absolutely painless and non-traumatic. After drying, the smear is stained and viewed under a microscope. A smear is a routine examination that will show the degree of purity of the vagina, the level of inflammation and the presence or absence of sexually transmitted diseases, the presence of candidiasis, bacterial vaginosis. However, a simple smear does not reveal a urogenital infection, such as chlamydia, ureaplasmosis, mycoplasmosis, herpes, cymomegalovirus, papillomavirus and others. This requires special research methods, which, if necessary, the gynecologist will definitely prescribe.

Another type of analysis by a gynecologist is a cytology test, known as a cancer cell test. This is a cervical cancer screening that is recommended every year for every woman. The gynecologist takes it during the examination, and if the office is equipped with a colposcope, then cytology is accompanied by colposcopy, which allows you to examine in detail the mucous membrane of the cervix, the changes on it and their nature.

Cytology is taken from the lower third of the cervical canal with a special brush, applied to a coverslip, fixed and studied under a microscope by a laboratory cytologist. In elderly women, such an analysis is taken from the upper third of the cervical canal, and this is due to the peculiarities of the anatomy and physiology of this age. In women of reproductive age, the junction of the epithelium of the cervical canal and the epithelium covering the outer part of the cervix is located in the lower third. In older women, it moves to the upper third of the canal, and in girls up to 21-23 years old, it is often located on the outer part of the cervix. Cytology is taken from the junction of the epithelium, since it is here that cancer cells are most often formed. These are the main tests that the gynecologist takes during the appointment.

Subject: Candles BETADINE

I passed 2 standard tests at the gynecologist -

on flora and cytological, and the second turned out to be

not very good, as the doctor said, it shows

inflammation, and prescribed me suppositories BETADINE.

I heard that they are with iodine, and I asked the doctor

Reader Nedug.Ru

This is a tool from the series in one fell swoop of all the flies with a beating.

It is more correct, of course, to identify a specific causative agent of inflammation and its sensitivity to drugs. But your doctor should be more visible.

Betadine is an antiseptic. It is commonly used for the prevention and treatment of bacterial vaginosis.

Contraindications: Hypersensitivity, hyperthyroidism, Duhring's dermatitis herpetiformis, thyroid adenoma, before radioactive iodine therapy.

Indications: Infections of the oral cavity and pharynx, acute and chronic vaginitis, mixed infections, non-specific infections, infections caused by Trichomonas, fungal infections.

Doctors' opinion:

Firstly, Betadine, as an antiseptic, is used to treat and prevent bacterial vaginosis. Secondly, Betadine is used to prevent inflammatory diseases of the pelvic organs during invasive interventions. Thirdly, in the daily life of a woman, Betadine provides the prevention of sexually transmitted infections. In addition, Betadine is a good alternative to frequent vaginal douches and douches. And the last. When using Betadine, it is important to remember that the earlier it is used, the less often antibiotics are needed.

Examinations and tests for women's health/Examination by a gynecologist

Quite often, patients are prescribed a huge number of tests, most of which are not informative for diagnosing a suspected disease. First of all, the doctor must rely on the clinical symptoms of the disease. The volume of studies assigned to a woman should clearly correspond to the clinical picture.

Checking everything and everything is not worth it.

Beauty expert Vera Shtukensia today tells her experience of visiting a female doctor and how she was examined in a gynecological chair. The first inspection took place back in the 90s, now everything could change!

A smear on the flora from the vagina

A smear for flora is a laboratory microscopic examination that characterizes the microflora in the urethra, cervix, and vagina.

What does a smear on flora show?

The smear is applied to glass and stained with special dyes that allow bacteria to be more clearly distinguished under a microscope. The following indicators are evaluated:

the number of leukocytes;
the number of red blood cells;
the composition of the flora;
the presence of trichomonas, gonococci, fungus;
the presence of lactobacilli.

What are the indications for taking a smear for flora?

complaints of pain in the lower abdomen, discomfort in the genital area, itching, unusual vaginal discharge;
preventive examination by a gynecologist. about 1 time in 3-6 months;
pregnancy planning;
pregnancy;
long-term treatment with antibiotics, hormones, cytostatics;
change of sexual partner.

How to prepare for research?

Before visiting a gynecologist for testing, you should:

refrain from sexual intercourse for 1-2 days.
do not use vaginal preparations and do not douche for 2 days.
before taking a smear on the flora, it is recommended not to urinate for 2-3 hours.

It is advisable to take a smear on the flora immediately after menstruation. on day 4-5 of the cycle.

How is a swab taken for flora?

The sampling of material for a smear on the flora is carried out by a gynecologist with a disposable spatula from three points from the urethra, cervix and vagina. The pap smear procedure is painless.

How many days is a smear prepared for flora?

1 business day.

How is the result of a smear on flora evaluated?

Normally, rod flora and single leukocytes are determined in a smear.

Coccal flora, a large number of leukocytes, erythrocytes are present in the smear during the inflammatory process. Detection of Trichomonas indicates trichomoniasis. gonorrhea gonococci. Very often in smears on the flora, threads of the mycelium of the candidiasis fungus are found. or milkmaid.

Why is planting on flora carried out?

Sowing on the flora allows you to determine the species and number of bacteria and determine the sensitivity to antibacterial drugs.

Sources: moirezepti.ru, www.clinicasolncevo.ru, www.ginekologspb.ru, www.forum.nedug.ru, rentaldj.ru, medportal.ru

You should visit a gynecologist once every six months and be sure to take gynecological tests. Even if there are no complaints in this area, it is still not worth postponing a visit to the doctor. Analyzes at the gynecologist are given to detect or correctly diagnose the disease and prescribe treatment. Depending on the causes and symptoms with which the patient turned to the doctor, laboratory and microscopic studies are selected.

What tests are taken by a gynecologist

The list of gynecological tests is quite extensive and specific, so it is worth describing gynecological studies in more detail:

Smears for flora- a common gynecological analysis is not traumatic and practically painless. This is a routine method that is mandatory for any examination by a gynecologist. A smear will help determine the degree of cleanliness of the vagina; if available - the level of the inflammatory process; the presence or absence of candidiasis (thrush), sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea); bacterial vaginosis. The fence is made from several points: the posterior fornix of the vagina, the cervical canal (cervical canal), the urethra.
PCR smear you will be asked to take a gynecologist to get more accurate test results. This method allows you to detect the DNA of pathogens such as ureaplasmosis, mycoplasmosis, chlamydia, human papillomavirus. These infections are secretive, which is why this diagnostic method is so important. This is the most reliable and informative method for detecting STDs.
Bacteriological culture is a study of biological material from the genital tract or blood. Bacterial reproduction is stimulated, which makes it possible to identify even those pathogenic microorganisms that are present in small quantities. Also, this method makes it possible to conduct a test for the sensitivity of the pathogen to antibacterial drugs.
Pap test or cytological studies (in everyday life it is called "analysis for cancer cells"). This analysis in gynecology is mandatory for the diagnosis of pathologies of the cervix. Even if the woman is not bothered by anything, visually the cervix seems healthy, a scraping of the cervix for cytological examination should be performed once a year. The procedure is practically painless. The smear should be taken from the lower layers of the epithelium, because. malignant processes begin there.
Colposcopy This is a procedure for examining the cervix. The cervix is examined using a special microscope - a colposcope, which allows you to determine the first signs of malignant tumors and diagnose erosion of the cervix and ovaries.
biopsy appointed, if necessary, by the decision of the attending physician. This is some analogue of cytology, but it is not individual cells that have fallen into the smear that are examined, but a tissue section in the area that aroused suspicion.

Where to take gynecological tests

Our paid private gynecology will provide high-quality, quickly performed gynecological tests at an inexpensive cost. And gynecological tests are the starting point for further competent treatment by our specialists. Do not risk your health, contact qualified specialists.

Prices for gynecological tests are indicated in the table.

The list of services offered by the ONMED medical center includes gynecological tests without fail. We perform all types of procedures that relate to the diagnosis of diseases, pregnancy planning or treatment control. We will help you solve absolutely any problem related to women's health in the genital area.

Blood analysis

blood analysis;
histological analysis;
definition of all types of infections;
diagnosis of any viral diseases.

In modern medicine, gynecological tests are carried out on the basis of different biomaterials. The most basic of them is a smear on the flora, which is taken during the initial or regular examination. The process of taking a smear is quite fast and absolutely painless.

Comprehensive examination at the medical center "ONMED"

Our center offers its patients a comprehensive examination according to special programs that we have developed in order to obtain the most detailed information. We offer:

prepare for pregnancy;
diagnose any diseases that are sexually transmitted;
take tests for women who have entered the period of menopause.

In addition to the usual and testing, our specialists resort to additional methods to clarify the diagnosis. In the medical center "ONMED" in the field of gynecology, many modern diagnostic methods and devices are used.

Ultrasound in gynecology

This is an indispensable way to diagnose diseases of the pelvic organs. It makes it possible to identify various inflammatory processes, and also determines the nature of the course of the disease.

Laparoscopy

In gynecology, this procedure is used to identify and remove any adhesive process:

ovarian cyst;
myoma;
polyps.

Thanks to the use of a laparoscope, it is easy to restore the patency of the fallopian tubes.

Hysteroscopy

It is performed using a special device that is necessary for examining the uterus. This device not only allows you to detect, but also simultaneously remove neoplasms.

Modern laboratory research of gynecological tests

Specialists of the ONMED Medical Center will select the most effective and accurate diagnostic methods for you. High-quality materials, reliable equipment and experienced staff will ensure the result of your treatment at the highest level.

We offer the following types of gynecological tests:

polymerase chain reaction;
smear analysis;
bakposev;
blood test for hormones.

Testing for different types of infections

The correct definition of infection makes it possible to prescribe effective treatment. The list of prescribed gynecological tests depends, first of all, on what complaints you came to the gynecologist with; each clinic determines the prices for them at its own discretion. Tests for infections can be taken from:

vagina;
cervix;
urethra;
anus.

All kinds of female diseases can manifest with different symptoms and have an uncertain medical picture. To clarify the situation and make the correct diagnosis in gynecology, many different methods for diagnosing infections are used.

Examination in gynecology

You begin to be tormented by vague doubts that your hormonal background is not in order: hair in the wrong places, an irregular cycle, an enlarged thyroid gland, weight changes, oily skin, etc. I don’t want to think that this may be an age-related normal, a consequence stress, the result of malnutrition and lifestyle, a hereditary trait. I want to find the culprit - the wrong hormone - and fight it with a pill. Take a pill and forget the problems. Of course, this is much easier than dieting or exercising or regularly visiting a beautician, etc. Those hormones that are made in the nearest available laboratory are surrendered - a certain random set of indicators without taking into account the day of the cycle and daily biorhythms. If the analysis for hormones turns out to be normal, bewilderment arises - what is the matter then? Questions begin from the series "I checked everything - everything is fine, what should I do?"

In fact, all tests require clear indications. For each clinical situation, there is a specific examination plan, which includes a set of tests - in a certain order, subject to certain conditions. Only then the results of these tests will really help your doctor, otherwise he will put aside all the papers you brought and write a new list, and you will worry about the lost time, money and blood (in the literal sense of the word).

In addition, each doctor during his work, receiving the results of analyzes made in different laboratories, and comparing them with what he sees - with complaints, with the results of treatment - draws a conclusion about the reliability of some laboratories. And about the unreliability of most others. Naturally, a real doctor cannot prescribe treatment based on unreliable analyzes and treat who knows what. And precisely because the attending physician, and not the laboratory, is responsible for the health of the patient, a decent attending physician sends to those laboratories whose results he trusts. Of course, it is difficult to distinguish this motive from a simple desire to make money on tests, and here the question is about personal trust in the attending physician. And if you trust him, know that such behavior is more often in your interests. Therefore, it is always better not to wander around the laboratories and take tests yourself, and then come to the doctor with a bundle of papers; but first to find His Attending Doctor, who will already write a list of tests that he considers necessary, and a list of laboratories where he advises to take these tests. The examination algorithms given below are given as a guide, for an idea of what needs to be done in a given situation, so that you know where to run if there is no doctor yet and no one really tells you anything. But no algorithm is a dogma and cannot take precedence over the individual prescriptions of a personal attending physician.

And of course, this is just an examination algorithm, and not a guide to self-diagnosis and self-treatment. Only a doctor can interpret all the received tests.

So, the survey algorithms required in the following situations:

I just want to pass "on hormones"(determination of hormonal status)

1. On days 5-7 of the cycle (1 day of menstruation - 1 day of the cycle) the following hormones: LH, FSH, estradiol, prolactin, testosterone, DHEA-S, DHEA, cortisol, 17-hydroxyprogesterone, TSH and free T4.

Stress hormones: prolactin, cortisol, LH - can be elevated not due to hormonal diseases, but due to chronic or acute (going to the hospital and donating blood from a vein) stress. They need to be resubmitted. For the diagnosis of "hyperprolactinemia", for example, it is necessary to measure elevated prolactin levels three times.

2. Progesterone it makes sense to take only in the middle of the second phase of the menstrual cycle. After 3-5 days of a stable rise in basal temperature, with an ultrasound picture of the second phase (corpus luteum in the ovary and mature endometrium), progesterone can be taken (with a regular 28-30 day cycle - on day 20-23).

All hormones are taken strictly on an empty stomach, like any blood tests.

If it is not possible to donate the right hormones on the right days of the cycle, it is better not to donate at all than to donate on other days of the cycle. The analysis will be completely uninformative.

Delayed menstruation

1. Home pregnancy test

In the morning portion of urine, it is indicative only from the first day of delay. False negatives are more common than false positives.

If negative:

2. Ultrasound with a vaginal probe

If the ultrasound picture of the mature second phase of the cycle (thick mature endometrium, corpus luteum in the ovary):

3. Blood for beta-hCG

If negative- wait for menstruation, it will be soon.

If doubtful- retake after 48 hours. With a developing uterine pregnancy, the indicator will increase by 2 times.

If there is no picture of the second phase on the ultrasound, then this is not pregnancy, and it is far from menstruation. This is ovarian dysfunction, you need to go to the gynecologist with it and figure it out - whether to wait or help with vitamins, herbs, hormones, etc.

If a home pregnancy test is positive, a vaginal ultrasound should still be done to understand the location of the pregnancy (uterine or extra-) and its viability (heartbeat/no). When the test is positive, pregnancy is already always visible on ultrasound with a vaginal probe. The heartbeat is visible from 5 weeks (from 1 day of the last menstruation with a regular cycle). Frequent ultrasounds at any stage of pregnancy, including early ones, are absolutely harmless. Much more dangerous are the extra days lived with an undiagnosed ectopic or missed pregnancy.

Absence of menstruation for several months, irregular cycle

2. After exclusion of pregnancy - determination of hormonal status ()

3. Computed or magnetic resonance imaging of the Turkish saddle (exclusion of a pituitary tumor)

Choice of hormonal contraception

1. Biochemical blood test with an emphasis on the lipid spectrum (total cholesterol, HDL, LDL, VLDL, triglycerides), fasting glucose, liver parameters (total bilirubin, direct, total protein, albumin, ALT, AsAT, gamma-GT)

2. Hemostasiogram and coagulogram (blood coagulation parameters: fibrinogen, prothrombin index, APTT, AVR, thrombotic potential index, platelet aggregation level, fibrin degradation products.)

3. Ultrasound of the pelvic organs 2 times per cycle - after menstruation and before the next menstruation. Evaluation of the growth of the follicle, the endometrium, the presence of ovulation, the formation of the corpus luteum and the maturation of the endometrium. Exclusion of possible diseases of the small pelvis, diagnosed by ultrasound. Vaginal probe only.

5. Examination by a therapist, control of blood pressure and condition of the veins.

Preparing for a planned pregnancy(first or subsequent)

0. Spermogram. Desirable, although not required at the beginning of planning. It is done not so much to assess the ability to bear children, but to determine the quality of spermatozoa (the number of pathological forms, for example) and identify a hidden inflammatory process (much more informative analysis than any smears and PCR).

1. A trip to the dentist, therapist, ENT (treatment of chronic tonsillitis is very important!)

2. Examination by a gynecologist, colposcopy

3. Blood type, Rh factor for both spouses

If a woman has a positive Rh factor, there is no problem.

If a woman has a negative Rh factor - antibodies to the Rh factor (even if a man is also negative).

If they are positive, pregnancy is not currently possible and needs to be corrected.

If negative - repeat this analysis once a month, starting from 8 weeks of pregnancy.

If a woman has 1 group, and a man has any other group, incompatibility by blood types is possible. An analysis for group antibodies, as well as an analysis for antibodies to the Rh factor, is carried out once a month, starting from 8 weeks of pregnancy.

4. TORCH-complex. Antibodies to rubella, toxoplasma, herpes, CMV, chlamydia - quantitative analysis (with titer). The presence of IgG antibodies means immunity to these infections, and is not an obstacle to pregnancy. The presence of IgM means an acute stage, planning in this case must be postponed until recovery. If there are no IgG antibodies to rubella, it is necessary to be vaccinated and protected for another 3 months after it. Do not ask your parents if you had rubella, it is impossible to know for sure - it can occur under the mask of acute respiratory infections and vice versa. Only a blood test for antibodies can give accurate information.

5. Tests for infections: regular smear, PCR for latent infections - both.

7. Graph of basal temperature. From 6 to 8 in the morning, at the same time, without getting out of bed, with a mercury thermometer for 5 minutes in the rectum. All deviations from this regimen and special circumstances (drugs, ailments, sleep disorders, menstruation, sexual activity, stool disorders, etc.) should be noted in a special column.

8. Hormones - adrenal androgens and characterizing the state of the thyroid gland. DHEA sulfate, 17-hydroxyprogesterone, TSH, free T4, anti-thyroid peroxidase antibodies. any day of the cycle.

9. Hemostasiogram, coagulogram ()

10. Determination of lupus anticoagulant, antibodies to chorionic gonadotropin, antibodies to phospholipids - factors of early miscarriage.

11. General clinical blood test (hemoglobin, erythrocytes, leukocytes, platelets, ESR, color index, leukocyte formula). Finger blood.

12. General analysis of urine (morning portion of urine - completely collected, while it is important that the analysis does not include discharge from neighboring organs).

Pregnancy

From the moment of establishment (test, blood test), then once a trimester is mandatory, once every 4-6 weeks it is desirable, in case of violations - 2 weeks after the correction.

1. Ultrasound. Establishment of uterine developing (palpitations +) pregnancy. Control of development, compliance with the terms, exclusion of malformations, placental insufficiency, threats of miscarriage. After 8 weeks - a conventional sensor. Not harmful.

2. General clinical blood test ()

4. Urinalysis according to Nechiporenko, if there are doubts in the general analysis.

At the same time, the average portion of morning urine is collected in a jar.

6. Lupus anticoagulant, antibodies to phospholipids, to hCG.

7. Antibodies to rubella, toxoplasma (if you haven’t taken it yet), herpes, CMV (in any case)

8. Rh antibodies and group antibodies in case of incompatibility from 8 weeks.

9. Daily urine for 17-KS.

17-ketosteroids are metabolic products of male sex hormones. This analysis allows you to evaluate the total level of all male hormones per day. This is its advantage over a blood test for individual hormones, which determines the level of individual hormones for a certain time and is thus less sensitive. Daily urine for 17-KS allows you to catch any fluctuations per day of any male hormones. Although this analysis is older and less convenient, it is no less informative.

3 days before collection and on the day of collection, coloring foods (yellow, orange, red) are excluded from food: carrots, beets, red apples, citrus fruits (all including juices, salads, sauces, soups, etc.), vitamins. Otherwise, the indicator will be overestimated.

On the day of collection, the first morning portion of urine is not collected. Further, all day, all night and the first morning portion of the next day (at the same time as the day before, i.e. so that exactly 24 hours pass between two morning portions) are collected in one large container. Further, the volume of daily urine is carefully measured with a measuring cup (the accuracy of the analysis depends on the accuracy of the volume) and is recorded on a piece of paper along with the full name. The contents of the container are mixed and poured into a small jar, like a regular urine test. The level of 17-COP will be converted to the total daily volume indicated on the piece of paper.

If it is available in your laboratory - blood for DHEA-S and 17-hydroxyprogesterone.

10. Tests for infections - smear and PCR (cm)

11. TTG, St. T4, anti-TPO antibodies - thyroid condition.

At 15-16 weeks additionally:

1. Markers of some defects and placental insufficiency: AFP (alpha-fetoprotein), free estriol, beta-hCG and 17-hydroxyprogesterone.

Analyzes are interpreted together with each other and with ultrasound data, real deviations are changes several times compared to the norm. The significance of these parameters is indirect. With unfavorable and doubtful indicators + the presence of risk factors (age, genetics, history, etc.), according to indications - amniocentesis or cordocentesis - sampling of fetal cells for chromosomal analysis. This is the same study for the exact determination of gender.

2. Ultrasound with a vaginal probe to determine the length of the closed part of the cervix - diagnosis of isthmic-cervical insufficiency.

In the second and third trimester

If there are signs of possible placental insufficiency, intrauterine growth retardation, according to indications - dopplerometry (a type of ultrasound with determining the degree of blood flow).

From 33 weeks

CTG (cardiotocography) - determination of the state of the fetus by analyzing its cardiac activity and motor activity. The only study that allows you to determine the condition of the fetus, and not the mother's body. It is necessary to come to CTG not on an empty stomach, in a normal, well-fed and alert state, because during the child’s sleep, the indicators will be underestimated, and the examination time will have to be extended (normally 40-60 minutes).

Examination after a frozen, interrupted pregnancy

2. Ultrasound of the pelvic organs with a vaginal probe ()

3. Measurement of basal temperature ()

4. Determination of hormonal status ()

5. Hemostasiogram, coagulogram ()

6. Determination of lupus anticoagulant, antibodies to chorionic gonadotropin, antibodies to phospholipids.

8. Tests for infections: regular smear, PCR for latent infections. (cm)

9. Hysterosalpingography - checking the patency of the fallopian tubes.

It is done on the 18-21st day of the regular menstrual cycle (in the middle of the second phase). The whole cycle in which the HSG is done, from the very beginning, must be strictly protected and not hope that since nothing has worked so far, it will not work any further. An x-ray of the uterus in early pregnancy is an absolute indication for its termination. Three days before the GHA, you need to prepare for it - no-shpa, valerian; the day before to make an enema, in the morning - a light breakfast. Get ready for the sensations, as during menstruation.

10. Determination of antisperm antibodies in semen (MAR test), cervical fluid (during ovulation), if necessary - in the blood, postcoital test.

11. Laparoscopy. To exclude endometriosis, accurately check the patency of the tubes, diagnose unexplained infertility - a combination of diagnosis and treatment. It is better to carry out in the first phase of the cycle. General anesthesia.

Chronic itching of the genitals

1. Gram flora smear

2. Bacteriological examination - sowing with the determination of sensitivity to antibiotics

4. Determination of markers of hepatitis, HIV infection, syphilis (RV, HIV, HbSAg, anti-HCV)

If not:

6. History taking - itching in other parts of the body, pruritus (lymphomas, multiple myeloma, diabetes, thyroid pathology, scabies, neurodermatitis, urticaria, pathology of the gastrointestinal tract, liver, kidneys, drug exposure, drugs), what means help

7. General clinical blood test (anemia, blood diseases, allergies, helminthic invasion)

8. Determination of fasting blood glucose (blood for sugar)

9. Urinalysis (infection, sugar, salts)

10. Examination by a gynecologist and dermatovenereologist, scraping and microscopy (contact dermatitis, scabies, pediculosis, urticaria, lichen planus, injuries /, herpes, papillomas, mycoses)

2. Detailed biochemical blood test ()

3. General clinical blood test ()

4. Analysis of hair for mineral composition

Overweight or underweight

1. Determination of hormonal status ()

2. Biochemical blood test with an emphasis on the lipid spectrum (total cholesterol, HDL, LDL, VLDL, triglycerides), fasting glucose, liver parameters (total bilirubin, direct, total protein, albumin, AlAT, AsAT, gammaGT), as well as conduct a test for glucose tolerance.

Checking the condition of the thyroid gland(unfavorable heredity, suspicions of thyroid pathology, deviations in the analysis of TSH and St. T4)

1. Retest hormones TSH, free T4 and free T3

2. Antibodies to thyroid peroxidase and thyroglobulin

3. Ultrasound of the thyroid gland.

(The main of these analyzes is the first one. With unimpaired hormonal function of the thyroid gland, the very presence of antibodies or ultrasound signs of thyroiditis are not indications for treatment).

Pain, engorgement, induration in the mammary glands, discharge from the nipples

1. Breast ultrasound (if you are under 35) or mammography if more.

2. Determination of hormonal status ()

3. With a re-elevated level of prolactin, computed tomography (or better magnetic resonance imaging) of the skull (sella turcica) to exclude the pathology of the pituitary gland. X-ray of the Turkish saddle is uninformative and cannot replace MRI.

4. Mammologist's consultation

Climax- soon or already, selection of menopause replacement therapy, monitoring its effectiveness

1. Determination of hormonal status (). The test for menopause is an increase in FSH levels

3. Test for glucose tolerance.

4. Ultrasound of the pelvic organs with a vaginal probe ().

5. Examination by a therapist, control of blood pressure.

6. General clinical blood test ()

7. Hemostasiogram and coagulogram ()

8. Mammography

9. Examination for osteoporosis:

Two-photon densitometry or dual-energy x-ray absortometry.

Determination of bone remodeling markers in blood: hydroxyproline, pyridinoline, deoxypyridinoline, N-telo-peptide-NTX, bone isoenzyme alkaline phosphatase, osteocalcin.

Determination of the content of calcium and phosphorus in the blood is uninformative, as well as radiography of bones.

endometriosis

1. Ultrasound with a vaginal probe on the eve of menstruation. This is how endometrioid ovarian cysts and internal endometriosis of the uterus (adenomyosis) are diagnosed. For differential diagnosis with other ovarian cysts, repeated ultrasound is necessary.

2. Hysteroscopy - to confirm adenomyosis.

3. Laparoscopy - for the diagnosis (and immediately treatment) of external genital endometriosis of the peritoneum.

Ovarian cysts, tumors, formations

1. Repeated ultrasound. Functional cysts disappear on their own within 3-4 months.

2. Tumor markers (CA-125, CA-19, etc.). The analysis is non-specific, only a sharp excess of the indicators by several times matters. They will also be elevated with functional ovarian cysts.

3. Determination of hormonal status ().

The last point in all algorithms is consultation of the attending physician and his interpretation of the results. Further examination and treatment tactics depend on the results of the basic algorithm.